Clinical characteristics and outcomes of colorectal cancer in elderly patients, insights from a large database in Israel

Colorectal cancer is a prevalent condition among the elderly population. We sought to examine the clinical and endoscopic characteristics of patients over age 75 diagnosed with late-onset colorectal cancer (LOCRC). We included patients with confirmed colorectal cancer (CRC) diagnosis in a national cohort from a large health service provider (Clalit), and a local cohort in a single tertiary center (years 2000-2023). We collected data regarding demographics, indications, comorbidities, endoscopic data, and laboratory values. A total of 27 465 patients in the LOCRC group were compared with 40 594 younger patients. The mean age of each group was 82.7 ± 5 vs. 61.5 ± 10.8 years P < 0.001. Comorbidities were more common among the LOCRC group (diabetes mellitus, hypertension, and iron deficiency anemia respectively). In the local cohort, rectal bleeding was a less common indication in patients with LOCRC (15.4 vs. 21%), while constipation (18.2 vs.8.4%), anemia (28.3 vs 13.4%), and weight loss (13.8 vs. 7.4%) were more prevalent. Patients with LOCRC had more right-sided colon cancer (43.9 vs. 33.7%; P < 0.001). Disease staging showed a higher proportion of younger patients in stage IV (22.4 vs. 17.8%; P = 0.005), whereas older patients were more frequently classified as stage II (31.3 vs. 27.6%; P = 0.036). Surgical intervention was more frequent among older patients (86.2 vs. 71.2%; P < 0.001). The study highlights the differences in clinical and endoscopic characteristics of late-onset CRC. The findings underscore the need to refine diagnostic pathways and screening strategies tailored to elderly patients.